Doomsday predictions about bird flu seem to be spreading faster than the virus itself. But a small group of skeptics say the bird flu hype is overblown and ultimately harmful to the public’s health.

There’s no guarantee bird flu will become a pandemic, and if it does there’s no guarantee it will kill millions of people. The real trouble, these skeptics say, is that bird flu hysteria is sapping money and attention away from more important health threats.

While I agree with some points the so-called “skeptics” make (we don’t know if H5N1 will become pandemic, some people’s concern about “bird flu” is disproportionate to the threat, etc.), what I don’t agree with are their strawman characterizations of the public health response, discussed below.
First, a note on the skeptics interviewed for the article. One is Mark Siegel, who has two books to sell you: one on “bird flu” that I’ve not read, but have my doubts based on his interviews about it. The second is on the epidemic of fear perpetuated by the government. (Revere has a piece on him here).

The other is Wendy Orent, an author and anthropologist. (Revere’s discussed her a time or two–the combination of them both in an article must be making his head spin). Her schtick seems to be that public health officials keep “exaggerating” the potential effects of a pandemic, even though, as Revere has detailed, her grasp of the science behind an influenza pandemic is a bit sketchy. Her contribution to the article:

“Ridiculous,” scoffed Wendy Orent, an anthropologist and author of “Plague: The Mysterious Past and Terrifying Future of the World’s Most Dangerous Disease.”

She said public health officials have vastly exaggerated the potential danger of bird flu.

(An aside: This was in response to Robert Webster’s comment that half the population could die from an influenza pandemic, which I’ve not seen Webster clarify.)

Anyhoo, onto Siegel’s contribution:

He said he’d like to see more efforts at general pandemic preparation — such as developing better methods for making vaccines — rather than a laser-like focus on H5N1.

It takes a “skeptic” to say this? This is exactly what most of us have been emphasizing all along–general preparedness. Better surveillance for emerging diseases, no matter what they are. Money for response. Money for better vaccination development techniques. All-hazards approach, yada yada yada. Emphasis on H5N1 is obviously in the headlines because we’re watching the virus spread in real-time, but I’ve not heard anyone suggest that H5N1 is our only concern. That’s a strawman.

The problem with getting the message out about low-probability, high-impact events is, as I mentioned previously, is two-footed driving: raise awareness without scaring. A quote in the article by consultant Peter Sandman emphasizes that:

“It’s unfair and dishonest to make it sound like we’re sure H5N1 is coming soon and it’s going to kill half the population,” Sandman said. “It’s equally irresponsible to say, because only a hundred people have died, it’s not a biggie. It’s potentially very scary, but potentially is only potentially.”

Leavitt said pandemic diseases are difficult to discuss because anything said prior to an outbreak can be considered “alarmist” and anything said after “seems inadequate,” so his job is to find a balance between the two.

See, here’s the thing about preparedness and information. The general public, largely, isn’t stupid. Even when faced with terrible events, panic is fairly rare. People frequently pull together and do what needs to be done. And I’m not just pulling this out of my ass here–as someone who’s had a longstanding interest in bioterrorism, I’ve studied these issues. One paper of interest is this one:

Bioterrorism policy discussions and response planning efforts have tended to discount the capacity of the public to participate in the response to an act of bioterrorism, or they have assumed that local populations would impede an effective response. Fears of mass panic and social disorder underlie this bias. Although it is not known how the population will react to an unprecedented act of bioterrorism, experience with natural and technological disasters and disease outbreaks indicates a pattern of generally effective and adaptive collective action. Failure to involve the public as a key partner in the medical and public-health response could hamper effective management of an epidemic and increase the likelihood of social disruption. Ultimately, actions taken by nonprofessional individuals and groups could have the greatest influence on the outcome of a bioterrorism event. Five guidelines for integrating the public into bioterrorism response planning are proposed: (1) treat the public as a capable ally in the response to an epidemic, (2) enlist civic organizations in practical public health activities, (3) anticipate the need for home-based patient care and infection control, (4) invest in public outreach and communication strategies, and (5) ensure that planning reflects the values and priorities of affected populations. (emphasis mine)

Obviously, this is geared toward a response to bioterrorism, but it’s also applicable in the event of a pandemic influenza. I think it’s wrong to condescend to the public–to treat y’all like delicate little flowers who “can’t handle” all the information being given to you, so that you become incapacitated by fear. I can understand people getting burned out on all the influenza updates. For those of you who feel that way, tune out. It’s easy enough to do. Don’t read the articles. Don’t listen to the interviews. We can’t make you be informed about influenza, or any other public health issue. But I’m glad there are a lot of laypeople out there who are listening, and getting involved. In my opinion, that shows that there’s a lot more to the news coverage than just “fear-mongering.” Again, from the article I linked by Glass and Schoch-Spana:

As demonstrated by community reactions to the terrorist attacks in New York and Washington, D.C., the power of the public to respond effectively to disasters should not be underestimated. In New York, individual volunteers and organized groups converged on the epicenter of destruction to offer aid and support, despite hazardous conditions and uncertainty about the risks of further attack or structural collapse of the World Trade Center towers. Volunteers responded rapidly and in large numbers to help in search and rescue efforts while professional operations were yet to be put in place. Since the attacks, affected communities have been organizing through local government, relief groups, and civic organizations, such as churches, neighborhood associations, and labor organizations.

And therein demonstrates the potential of education. The 9/11 attacks were largely out of the blue as far as the public was concerned, but people put themselves in danger and pitched in. An influenza pandemic, should one occur, shouldn’t be a surprise attack–but the response can be much the same: government entities and local groups working together to ameliorate suffering as much as possible. IMO, the more information that’s put out there prior to such an outbreak in order to allow the public to educate themselves on the matter, the better, no matter how much the “skeptics” scoff at “fear-mongering.” Knowledge is power.

Unfortunately, it is very early in the storm season and we could possibly see more violent weather come our way. It is imperative that we all educate ourselves and take the necessary precautions to enhance not only our own safety, but also that of others.

Odds are that the town won’t get hit by another serious tornado for awhile, but is it “fear-mongering” to suggest that people educate themselves and take precautions? Why is it different, and scientists called “Chicken Littles” when we advise the same about influenza or other public health threats?]

As a kid, I remember Civil Defense, which pretty much did what you recommend. Then Carter decided only “experts” paid by the federal government were smart enough to deal with natural disasters, disease out-breaks, etc. Say “Hi!” to FEMA. Of course FEMA tries to use locals, but only by dressing them in colorful shirts, teaching them to answer every question with “I don’t know, call FEMA’s 800 number,” and generally setting them up to take all the heat while actively suppressing any attempts to actually, you know, help people.

Apparently, there’s going to be a made-for-TV movie about the avian flu broadcast soon. The previews looked plain awful, like the avian flu was something like the Andromeda Strain or War of the Worlds (to reference two disaster movies). I think it’ll be on ABC.

One of the points she made was that any resonse taken against the possible threat of a H5N1 influenza pandemic should also be applicable to any other future possible epidemic. She was a bit dsimissive of stockpiling Tamiflu for instance. It seems like a good point the basic infrastructure and procedures to cope with any epidemic should be similar.

I have read your work so often I almost feel like I’m visiting a friend. Thanks for all you do.

Anyway, I just wanted to say, as I have so ofter, that every year I pay thousands of dollars for various and sundry insurances against the possibility of disaster or misadventure. No one thinks I’m a loon for doing so. In fact, quite the contrary, I’m considered a responsible citizen of my community and a good spouse and parent.

Now, I spend that money not because I KNOW I’m gonna need it, in fact I hope fervently that I don’t, but because I MIGHT need it.

I look at pandemic preperations in exactly the same light, both for my personal preps and any preps taken by our governments and health care systems.

People may not be idiots, but “the public” does tend to be. I’ve met very few people who have gone into a panic about the bird flu, but groups of people seem to go crazy, demanding the government “do something,” usually in response to the latest batch of reported deaths or frightening theories. While blogs like yours quietly present realistic facts, the media try to spin things to gain ratings. So while a measured balanced viewpoint is the best, it’s less likely to be published than a skeptics attack.

Pagan said: “I’ve met very few people who have gone into a panic about the bird flu, but groups of people seem to go crazy, demanding the government “do something,” usually in response to the latest batch of reported deaths or frightening theories.”

You don’t always see it, but it happens on an individual basis as well. Maybe it’s just MY perspective, but if a family stops buying Zacky Farms products and eating turkey on Thanksgiving because of what they THINK is being said – They ARE in a panic. You don’t have to run up and down the street screaming “the birds! the birds”, to be a little crazy. But you are totally right about the media – the REAL culprit here, not the medical establishment.

What drives me crazy about Orent and the other skeptics is that the preparations needed to combat pandemic flu could be harnessed to prevent most of the 37,000 deaths/year from ordinary flu (e.g., increased surge production capacity of vaccine).

I think Tara makes a great point about citizen action during a crisis. Also about keeping informed about public health and safety issues. It seems to me this was one of the factors that exacerbated the damage of the Katrina disaster in New Orleans. Some officials did not try to work with or involve citizens in the recovery effort, and in fact actively discouraged and antagonized them, treating them either like sheep or criminals. Witness the story of the group of Katrina survivors who were prevented from leaving New Orleans after the disaster by police in neighboring suburbs afraid of having to deal with refugees.

Sci Fi author David Brin also makes the point in some essays on his website about how citizens are competent. I’m too young to remember it, but I think Just A. Drifter’s notion about bringing back civil defnese is not a bad idea.

I’m not sure if that’s a serious post or a joke, but assuming the former, do you have any idea what a “quarantine” is, Mia? It’s keeping people who have been exposed to the virus–but aren’t yet sick–contained for what can be a very long length of time. So what you’re suggesting is that everyone be locked up within their house, even though H5N1 hasn’t even appeared in the US yet. Does that make any sense to you?

Alternatively, we could quarantine everyone who enters the country to keep them from bringing H5N1 in and exposing people, but again, that would be a huge–and incredibly, incredibly wasteful–undertaking. Indeed, most response strategies don’t even invoke quarantine, because it’s such a logistical nightmare–truly a last-ditch effort. It can be very effective (for example, in Asia during the SARS outbreak), but it’s been so long since it’s been in widespread use in the United States, it will be very difficult to institute any large quarantine.